Home blood pressure monitoring and the risk of falls in older adults with hypertension: The AMBROSIA-HOME study

Background: Concerns about hypotension and excessive blood pressure (BP) variability leading to falls may be a barrier to achieving BP treatment goals among older adults. Home BP monitoring (HBPM) may allow for better BP management while avoiding falls. Methods: Participants, aged ≥65 years taking antihypertensive medication (n = 541), were instructed in proper HBPM technique and asked to take 2 morning and 2 evening readings for 7 days. Among 499 participants with ≥4 days of HBPM, white coat effect was defined as mean clinic BP minus mean BP on HBPM. Day-to-day variability was calculated using standard deviation independent of the mean (SDIM). Participants reported falls monthly for 1 year. We estimated hazard ratios (HRs) for falls across quartiles of systolic BP on HBPM, white coat effect and SDIM, separately, adjusting for demographic characteristics and chronic conditions. Results: The mean ± SD age of participants was 74.2 ± 6.1 years, and 57.3% were women. Prefrailty and frailty prevalence were 50.7% and 3.4%, respectively. Participants in the highest versus lowest quartile of mean SBP from HBPM were older and more frequently male. Over 379 person-years, 187 participants reported falls. Comparing the highest and lowest quartiles, the HRs (95% confidence interval) were 0.85 (0.53–1.37), 0.84 (0.51–1.40), and 0.97 (0.62–1.51) for mean systolic BP, white coat effect, and SDIM, respectively. There was no evidence of associations between these measures for diastolic BP and falls. Conclusion: BP measured using HBPM was not associated with falls among older US adults with treated hypertension.